MEDICARE: IVY O'BRYANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1427847664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY O'BRYANT

Provider Business Mailing Address
First Line	:	4949 VISTA FLORA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2946
Country	:	US
Telephone Number	:	725-310-0699
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 VISTA FLORA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2946
Country	:	US
Telephone Number	:	725-310-0699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	05/05/2025

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Directions to “ IVY O'BRYANT ” Practice Location

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